Text Size

-

+

reset

To be clear, this isn’t just another bureaucratic deadline: What states choose to do with the Obamacare exchanges has long-term implications for the success of the landmark health care law, not to mention political consequences for the governors and state legislatures that choose to either carry out the law or turn over the keys to the federal government in building exchanges.

And states still trying to figure out what role, if any, they want in these new online insurance marketplaces include some where the governors have been pretty vocal about how much they oppose Obamacare: Utah’s Gary Herbert, Virginia’s Bob McDonnell, New Jersey’s Chris Christie, even Florida’s Rick Scott among them.

Although Friday is technically the final chance for states to make their exchange intentions known, the Department of Health and Human Services has shown flexibility on the verge of previous Obamacare deadlines, offering second, third and fourth chances for states to change their minds. And there are still several key rules HHS has to issue that states will need to fully launch their exchanges.

The next major dates on the law’s implementation calendar are Oct. 1, when enrollment is supposed to begin and Jan. 1, when coverage kicks in. Millions of people, many of whom are now uninsured or struggling to pay for coverage on their own, could qualify for federal subsidies to purchase private insurance in the new online marketplaces.

It’s sure to be an uneven rollout, assuming implementation doesn’t get pushed back. But it’s coming, whether America is ready or not.

Already, things haven’t gone according to plan. Half the states have turned down constructing their own exchanges in favor of letting the Obama administration step in to do it for them. A handful of state governments will partner with HHS to handle limited pieces of the exchanges, but the bulk of operations will still be run from Washington.

Fewer than 20 — mostly Democrat-led states — are preparing to run exchanges on their own.

Several states have kept their intentions a mystery with a little less than two days to go on the partnership deadline.

In New Jersey, Christie has made clear he’s no fan of the health law, and he vetoed Democratic legislation that would have created an exchange. But he’s running a Democratic state and as a rising GOP superstar, he’s picking his spots carefully. He hasn’t ruled out a partnership — and some health policy experts who have been parsing his words think he may turn it down this week but consent to some shared responsibility down the road.

Florida’s Scott, meanwhile, has continued to vex conservatives with his hot-and-cold approach to the ACA. Scott was once among the law’s most fervent critics, and Florida spearheaded the legal fight that went to the Supreme Court. But Scott has taken a more evenhanded tone in recent months, and Florida lawmakers sound willing to consider a partnership exchange.